When we think of dental care, we’re most often concerned with protecting teeth from plaque, tartar, and the damage caused by a sugary diet or poor hygiene. But there are other dangers to the teeth of both children and adults that are sometimes overlooked until the damage has been done. Similar to bones, teeth are subject to taking an impact—whether from an elbow at basketball practice, the ground in a fall, or even from the other teeth in a person’s mouth. Mouthguards are a common form of protection for teeth, but the options vary based on the type of protection a person needs. It’s important to discuss with a dentist what approach should be taken to ensure the teeth are safe from the dangers of sports or of a common condition known as grinding.
There are three main types of mouthguards: over-the-counter stock guards, boil-and-bite guards, and custom-fitted guards made by a dentist. While over-the-counter stock guards—typically used in sports—are inexpensive and convenient, local dentists typically warn against using them.
“Stock guards are inexpensive but bulky and offer minimal protection because they don’t fit well,” says Dr. Sarah Bienes, DDS, owner and general dentist at SB Dentistry. These guards are meant to fit in any given mouth, which means they aren’t tailored to the user’s teeth in particular. The lack of a custom fit can in some cases do more harm than good. Additionally, these guards require a person to clench the guard to keep it in place, which could limit the person’s ability to speak or breathe and thereby inhibit performance.
At Krewe of Smiles Pediatric Dentistry, Owner and Pediatric Dentist Christen Massey has seen exceptions to this rule.
“Sometimes, such as when a patient is currently in orthodontic appliances, stock mouthguards can still be the right choice,” she says. “Since different sports involve different risks, it’s best to talk to your dentist or dental specialist before selecting a mouthguard that meets the needs of your child’s specific activity.”
Boil-and-bite mouthguards present another option and provide a better fit than a stock mouthguard. As the name suggests, these thermoplastic protectors are heated in boiling water, cooled slightly, and then bitten to mold them to the shape of the upper teeth.
“They provide a better fit than a stock mouthguard since they are formed to the mouth directly but also have some limitations in terms of how long they will fit when a child is actively growing,” says Dr. Massey. “They also do not fit well over orthodontic appliances.”
The most often recommended guard (especially for adults) is a custom-fitted mouthguard designed from digital scans or physical impressions and made by a dentist.
“If you’re going to have one made, you definitely want to have your dentist make it,” says Dr. Hunter Charvet, co-owner at Charvet Dental Center. “The reason being, it’s going to be custom-fit to fit properly, and your occlusion (how your teeth meet) is going to be built into it.” Charvet recommends custom guards with “canine guidance” in instances of grinding to separate and take pressure off the posterior teeth.
Designed specifically for a person’s bite, custom-fitted guards stay in place, making it easier to breathe and speak while providing the best protection, comfort, and durability.
“If you get a boil-and-bite, they’re not always going to fit properly, and you can actually put more stress on the temporomandibular joint (TMJ), which can cause ache, pain, or even alignment issues with your teeth when you take that guard out,” says Dr. Charvet.
While Dr. Massey agrees that custom-fitted guards are typically the most comfortable and protective, she notes that they are not always the best choice for a growing child—jaws go through growth spurts, too—or if the child is currently wearing orthodontic appliances.
For adults, custom-fitted “nightguards” are a common recommendation for bruxism, better known as grinding, and should not be confused with sports mouthguards. Grinding is often an unconscious habit caused by factors such as stress or sleep disorders and impacts the teeth completely differently than a sports injury.
According to Dr. Massey, a nightguard provides stability to the temporomandibular joint (TMJ) and alters the patient’s bite temporarily to alleviate pain and further grinding. Night guards are made of rigid acrylic and cover the tops of the teeth.
“In contrast, sports mouthguards are designed specifically to absorb impact forces during physical activity,” she says. “They are made from softer, more flexible materials and are protectively worn during sports activities.”
Just as they have different purposes, mouthguards prevent different types of damage. What are the most common tooth injuries?
“The most common preventable injuries include chipped or fractured front teeth, enamel wear from grinding, and even tooth displacement during contact sports,” says Dr. Bienes. “A properly fitted guard either for sports or nighttime use can significantly reduce the risk of these issues.”
“We treat pediatric dental injuries quite frequently in our practice,” says Dr. Massey. “Most dental emergencies that report to U.S. emergency rooms are emergencies from children, and most of the injuries are children under the age of seven,” she says.
While some sports require the use of protective equipment, many do not. Dental injuries still occur in activities such as soccer, basketball, softball, skating, or trampoline use. While the majority of sports-related dental injuries involve the upper front teeth, other injuries can include lacerations, gingival damage, crown fractures, root fractures, and a knocked-out tooth.
“Numerous surveys and tests demonstrate the protective results of wearing a mouthguard, so we recommend mouthguards for any athlete,” says Dr. Massey.
And when it is time for a nightguard recommendation—how does a person (or parent) recognize bruxism?
“Bruxism is diagnosed through a combination of clinical exam and patient history,” says Dr. Bienes. “Early signs patients often miss include jaw soreness, morning headaches, tooth sensitivity, and subtle flattening of the teeth. Sometimes a partner notices grinding sounds before the patient is even aware of it.”
Similarly, parental observations can assist with diagnoses in children. Loud grinding noises while a child sleeps is a detail to discuss with a dentist. Other more subtle signs may include wear of the teeth, jaw pain, ear pain, headaches, muscle tension, difficulty opening the mouth, noises in the TMJ (locking, clicking, popping), indents on the tongue, and cheek or lip biting.
“When we’re doing their exam, you can usually see wear patterns on the teeth,” says Dr. Charvet. “You’ll see divots they’re wearing into, or their occlusion surface will now be flat or shiny. These are indications of clenching or grinding.”
While a dentist can usually see the evidence, many adults are often aware of their own clenching, feeling themselves at nighttime biting down hard. While the evidence may not be apparent to someone looking in the mirror, dental records can show these differences over various visits and confirm the existence of the condition.
“Over time, grinding can lead to significant enamel wear, fractures, gum recession, and even tooth loss in severe cases,” says Dr. Bienes. “It can also contribute to TMJ discomfort and chronic jaw pain. What starts as mild wear can progress into complex and costly dental issues if not addressed.”
Once bruxism is detected, the process to create a nightguard is typically simple and comfortable.
“We take a digital scan or physical impression of the patient’s teeth, which is used to fabricate the guard in a lab,” says Dr. Bienes. “Once it’s ready, the patient returns for a quick fitting appointment where we make any necessary adjustments to ensure a precise, comfortable fit. Digital scanning and 3D printing have significantly improved both the precision and turnaround time for custom mouthguards,” she says.
Dr. Charvet says that the initial scan/impression and the follow-up fitting are short, approximately 15-minute appointments about two weeks apart.
Adherence to wearing a nightguard can vary, but local dentists find that once a patient gets used to sleeping with the mouthguard, they don’t want to sleep without it.
“When people understand the long-term damage they’re preventing, they’re much more likely to stay consistent,” says Dr. Bienes.
“Sometimes patients will say they don’t want to wear a guard, and I try to warn them that it will be a lot more expensive if you end up breaking or fracturing teeth, losing teeth and putting implants in, or needing full-mouth rehabilitation where we reestablish your bite to what it used to be,” says Dr. Charvet.
Patients can rest assured in the fact that high-quality guards made by a dentist typically last several years, depending on wear. Mouthguards should be cleaned properly, using an ultrasonic cleaner or a solution made specifically for dentures, aligners, retainers, and guards. Aside from improper cleaning, common mistakes include exposing a mouthguard to heat or storing it in a closed container without proper ventilation. Signs it needs replacing include visible thinning, cracks, or a poor fit, and dentists recommend bringing your guard to your appointments so that it can be professionally checked and cleaned.
